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Volume 14 No. 07
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Scientific Investigations

Continued Presence of Period Limb Movements During REM Sleep in Patients With Chronic Static Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

Jonathan D. Santoro, MD1; Jennifer Frankovich, MD2; Sumit Bhargava, MD3
1Division of Child Neurology, Department of Neurology, Lucile Packard Children's Hospital at Stanford, Palo Alto, California; 2Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Palo Alto, California; 3Division of Pediatric Pulmonary and Critical Care, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Palo Alto, California

Study Objectives:

A major component of pediatric acute-onset neuropsychiatric syndrome (PANS) is disruption of sleep. These disturbances have been reported in the acute phase of diagnosis but it is unknown if these sleep disruptions persist, especially in patients with chronic static symptoms. This retrospective chart review sought to review polysomnography (PSG) tests of patients in whom PANS has been clinically diagnosed in order to assess sleep architecture, periodic limb movements, and presence of rapid eye movement (REM) sleep without atonia (RSWA) after a chronic static course of symptoms, which were refractory to immunomodulatory interventions.

Methods:

Patients were retrospectively identified through the PANS clinic at our institution and had to have fully completed a PSG study and be younger than 18 years. PSG with video were reviewed and scored based on established criteria.

Results:

We identified 9 patients who met inclusion criteria. The median time from presentation to PSG was 4 years. This study identified PSG-measured periodic limb movement index (PLMI) > 5 events/h in REM sleep in 7 of 9 patients. Two patients with elevated PLMI also demonstrated RSWA, although neither fit a clinical diagnosis of REM sleep behavior disorder. This cohort also demonstrated increased onset of REM sleep (median 134 minutes), insomnia (median total sleep time of 389 minutes), and decreased sleep efficiency (77%).

Conclusions:

This study identifies continued sleep disturbances in patients with refractory PANS symptoms several years after diagnosis and treatment. Continued sleep disturbances after presentation and treatment in patients with chronic static PANS may be a contributing factor in prolonged symptomatology of this disease process.

Citation:

Santoro JD, Frankovich J, Bhargava S. Continued presence of period limb movements during rem sleep in patients with chronic static pediatric acute-onset neuropsychiatric syndrome (PANS). J Clin Sleep Med. 2018;14(7):1187–1192.


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